Healthcare Provider Details

I. General information

NPI: 1700936572
Provider Name (Legal Business Name): BROWNSVILLE MEDICAL CLINIC, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 07/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 N CAVALIER DR
ALAMO TN
38001-6468
US

IV. Provider business mailing address

18 N CAVALIER DR
ALAMO TN
38001-6468
US

V. Phone/Fax

Practice location:
  • Phone: 731-696-4500
  • Fax: 731-696-2152
Mailing address:
  • Phone: 731-696-4500
  • Fax: 731-696-2152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CLAUDIA WHITE
Title or Position: ADMINISTRATOR
Credential:
Phone: 731-696-4500